STATE OF FLORIDA

DIVISION OF ADMINISTRATIVE HEARINGS

FLORIDA STATE BOARD OF NURSING, )

)

Petitioner, )

)

vs. ) CASE NO. 78-2212

)

CYNTHIA A. MEANS, )

)

Respondent. )

)

RECOMMENDED ORDER

Pursuant to notice a hearing was held before Delphene C. Strickland, Hearing Officer of the Division of Administrative Hearings, on May 16, 1979, beginning at 2:30 p.m. in the Bruce Manor Nursing Home, 1100 Pine Street in Clearwater, Florida.

APPEARANCES

For Petitioner: Julius Finegold, Esquire

1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

For Respondent: Martin J. Jones, Esquire

145 Fifth Avenue, Northeast St. Petersburg, Florida 33701

ISSUE

Whether the license of the Respondent, Cynthia A. Means, should be revoked or suspended, or whether Respondent should be otherwise disciplined for abuse of a patient.

FINDINGS OF FACT

1. The Respondent, Cynthia Ann Means Sapp, is a licensed practical nurse who holds License No. 0460011. She was employed at the Clearwater Convalescent Center during the month of August, 1978. An administrative complaint dated November 2, 1978, was filed by the Petitioner, Florida State Board of Nursing, alleging that the Respondent had physically abused an elderly patient in her care; that while administering medications in the course of her duties the Respondent left medications unattended and the door to the medication room unlocked; and that while dispensing medications the Respondent left the medication cart unattended. The Petitioner Board also alleged that the Respondent had injected a patient with 2,000 mg. of Tigan I.M., whereas the physician's order had called for only 200 mg. to be injected, and that when said patient was transported to the hospital she was diagnosed as having a marked atrial fibrilation secondary to the overdose of the Tigan. Respondent requested an administrative hearing.

2. Respondent admitted at the hearing that on or about August 11, 1978, while on duty as a licensed practical nurse at the Clearwater Convalescent Center in Clearwater, Florida, she had administered 2,000 mg. of Tigan I.M. to an 80-year-old patient in her care, although the physician's order had called for only 200 mg. to be injected. After being transported to the hospital said patient was diagnosed as being "in a marked atrial fibrilation with a marked decreased ventrical response probably secondary to the overdose of Tigan." Respondent expressed regret over the incident.

   
   

3. On or about August 14, 1978, Ms. Marie Parel, an elderly patient in the Clearwater Convalescent Center, was walking from the dining room with a walking cane. Said patient had a history of being more or less belligerent at times and would become upset when forced to do anything against her will. The Respondent attempted to get Ms. Parel into a Gerry chair and met with some opposition from her. A struggle ensued, and Respondent pushed, shoved and roughly forced Ms. Parel into the chair. During the struggle Ms. Parel was bruised on the face and arms. Ms. Parel became so upset that her daughter had to be called. The daughter talked to her mother, but Ms. Parel remained in an emotional state for several hours. The Respondent's actions were reported to the center's Director of Nurses by another nurse who was present at the time. Subsequent to this incident, the Respondent was discharged from her employment at the center.

   
   

4. There were no written or oral instructions given to employees of the convalescent center relative to the locking of the door to the medication room, or to the attendance or placement of the medication cart.

   
   

5. There is insufficient evidence to show that the Respondent did in fact leave the medication room unattended and the door unlocked, or that she left the medication cart unattended in the hallways and in the patients' rooms.

   
   

   CONCLUSIONS OF LAW

   
   

6. The Division of Administrative Hearings has jurisdiction of this cause pursuant to Section 120.57, Florida Statutes.

   
   

7. Section 464.21 Disciplinary proceedings.-- provides as follows:

   
   

   1. GROUNDS FOR DISCIPLINE.--The board shall have the authority to deny a license to any applicant or discipline the holder of a license or any other person temporarily authorized by the board to practice nursing in the state who has been found guilty by the board of:

      (b) Unprofessional conduct, which shall include any departure from, or the failure to conform to, the minimal standards of acceptable and prevailing nursing practice, in which proceeding actual injury need not be established.

      
      

8. The Respondent, Cynthia A. Means, violated the foregoing statute by departing from the standards of acceptable practice in injecting a patient with an overdose of medication to the extent that said patient suffered severe injury. The Respondent also violated the foregoing statute in treating an

elderly patient in such a manner that said patient was bruised and remained in an upset emotional state for a period of time.

RECOMMENDATION

Based upon the foregoing Findings of Fact and Conclusions of Law the Hearing Officer recommends that the Respondent, Cynthia A. Means, be placed on probation for a period not exceeding one year.

DONE and ORDERED this 6th day of July, 1979, in Tallahassee, Leon County, Florida.

DELPHENE C. STRICKLAND

Hearing Officer

Division of Administrative Hearings Room 101, Collins Building Tallahassee, Florida 32301

(904) 488-9675

COPIES FURNISHED:

Julius Finegold, Esquire 1107 Blackstone Building

233 East Bay Street Jacksonville, Florida 32202

Martin J. Jones, Esquire

145 Fifth Avenue, Northeast St. Petersburg, Florida 33701

Geraldine B. Johnson, R. N. Florida State Board of Nursing

111 East Coastline Drive, Suite 504 Jacksonville, Florida 32202

================================================================= AGENCY FINAL ORDER

=================================================================

IN THE MATTER OF:

Cynthia Ann Means Sapp

BEFORE THE FLORIDA STATE BOARD OF NURSING

As a Registered Nurse Case No. 78-2212

2220 U.S. Highway 19 North License Number 0460011

Bldg. 25, Apt. 242

Clearwater, Florida 33515

/

ORDER

This matter came on final action by the Florida State Board of Nursing on the 20th day of August, 1979, at 111 Coast Line Drive East, Suite 508, Jacksonville, Florida.

The Board, having reviewed the entire record, including all pleadings, exhibits admitted into evidence, the transcript of the hearing proceedings, the Findings of Fact, Conclusions of Law and Recommended Order of the Hearing Officer, rejects the recommended order as the agency's final order. The Board adopts paragraphs 1, 2, and 3 of the Hearing Officer's findings of fact. The Board, however, rejects the findings of fact found in paragraph 4 of the Hearing Officer's findings. The fourth paragraph states as follows:

There were no written or oral instructions given to employees of the convalescent center relative to the locking of the door to the medication room, or to the attendance or placement or use medication cart.

There is insufficient evidence to show that

the Respondent did in fact leave the medication room unattended and the door unlocked, or that she left the medication cart unattended in the hallways and in the patient's rooms.

The findings of fact found in the above-quoted paragraph were not based upon competent substantial evidence. The competent substantial evidence supports a finding, that the Respondent, Cynthia A. Means Sapp, did leave the door to the medication room unlocked and the medication cart with no one in attendance. (Transcript (( T )) 24, 25, 26, 27, 32, 33, 34, 35, 48, 49, 59, 60).

Specifically, Alice Russell, L.P.N., testified that the medication room in the south wing of the Clearwater Convalescent Center where Respondent was employed was unlocked and that it was the responsibility of the Respondent as a licensed practical nurse to ensure that the medication room was locked (T. 23- 24). Mrs. Russell further testified that controlled substances are kept in such medication rooms, and that the accepted practice of nursing requires that such medication rooms be locked (T. 26-27) This evidence is further supported by the testimony of Dorothy Vivian Batchellor, a nursing assistant at Clearwater Convalescent Center, reflecting that on at least one occasion, the Respondent not only allowed the medication room to be open during Respondent's duty shift, but moreover, Respondent departed from the premises while such medication room was open (T. 32). Ms. Batchellor further testified that Respondent left the medicine cart unattended from which drugs were dispensed (T. 34). There is competent substantial evidence to support the finding that leaving the medication room open presents a dangerous situation (T. 34-35). Ms. Batchellor further testified that the responsibility for the medicine room was not the nurse assistant's but that of the charge nurse, in this case, the Respondent (T. 32, 35, 49). The testimony of Marion Bryne, R.N., Director of Nursing at Clearwater Convalescent Center, further corroborates that Respondent left the medicine room unlocked and the medicine cart unattended (T. 59).

Moreover, Respondent admitted the allegations of Paragraphs 1 and 2 of the Administrative Complaint in that Respondent injected ten (10) times the

prescribed dosage of the drug Tigan to on 80-year-old patient which resulted in an overdose to the patient and necessitated hospitalization in the intensive care unit of Clearwater Community Hospital.

Under these circumstances, the Board is of the opinion that the recommended penalty of 1-year probation does not reflect the danger and seriousness of the violations in this matter.

ORDERED AND ADJUDGED that the licensed practical nurse, license number 0460011 of the Respondent, Cynthia Ann Means Sapp, be suspended for a period of three (3) years. However, it is ordered that said suspension be stayed after a period of fifteen (15) months and the licensee be placed on probation for the remaining period of twenty-one (21) months upon the following terms and conditions:

1. That the Respondent shall forthwith return license number 0460011 and current renewal receipt issued to practice nursing as a licensed practical nurse to the Florida State Board of Nursing. The failure to comply shall be deemed a violation of this condition of the probation.

   
   

2. That the Respondent refrain from violation of any law, Federal, State, or Local.

   
   

3. That the Respondent attend a refresher course in pharmacology and the administration of medication, and upon completion of such a course provide the Board with satisfactory completion of this course of study.

   
   

4. If employed as a nurse during the period of probation, that the Respondent have her employer to provide the Board with an evaluation of her nursing performance every three (3) months during the period of this probation. Such evaluations must prove to be satisfactory to the Board. The failure to comply with the terms of said probation shall be deemed a violation of thin Order.

DONE AND ORDERED this 31st day of August 1979, at Jacksonville, Florida.

FLORIDA STATE BOARD OF NURSING

BY:

Dorothy C. Stratton, R.N. President

BOARD SEAL

Copies furnished:

Cynthia Ann Means Sapp 2220 U.S. Highway 19N Bldg. 25, Apt. 242 Clearwater, Florida

Martin J. Jones, Esquire

145 Fifth Avenue, Northeast St. Petersburg, Florida 33701

Julius Finegold, Esquire

Docket for Case No: 78-002212

Orders for Case No: 78-002212